What matters? Waking levels vs fasting levels 2h later

Glink

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252
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Prediabetes
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I thought I had things under control (with LC diet + metformin) and had mostly stopped testing sugars, but I've been noticing an uptick in symptoms (excessive thirst, urination, hunger) so have started up again to try to see what's happening. One thing I notice is that my sugars right when I get up (say, 6:30) are much higher than they are a couple hours later (say, 8:30), which is the time I get bloods drawn for quarterly testing. My fasting quarterly tests have been okay (remaining in prediabetes, usually low prediabetic, range) but my waking levels are higher these days. I understand that this is likely due to dawn phenomenon, which then dissipates as I get up, move around, etc. over the next few hours. But, does it matter that my waking #s are high (crossing into "diabetic" range)? Can't find much info on this, so if you know of any I'd appreciate it. Thanks!
 

Bluetit1802

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When you say quarterly testing, do you mean the HbA1c test, or a simple blood glucose test taken from the arm?
If you mean the HbA1c test, you cannot compare it with your finger prick because they are looking at different criteria.
The HbA1c is a measurement of the amount of glucose stuck to your haemoglobin red blood cells and this measures average glucose over the previous 2 to 3 months. The simple blood glucose test and the finger pricks are just snapshots of your glucose at the time of the test.
 

Glink

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Every 3 mos my GP has me go in for fasting blood glucose and HbA1C testing, from my arm. The fasting, though, is generally taken a couple hrs after I actually get up, since the labs aren't open at 6.30h.

I basically am wondering if it matters that my waking FBG is high if the later-morning-still-fasting numbers are okay.

(I have other questions about the HbA1c, haha, but this is about just regular fasting BG.)
 

Alison Campbell

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I think it is great that your levels do not continue to rise after getting up as this is a common query on the forum.

Stangely my fasting average has gone up while my HBA1C has fallen a little.

I don't think either matters unless you are seeing numbers that you are not happy with at any time of day or if eating breakfast raises you above levels that cause damage. In the UK doctors rarely use fasting to diagnose.

I'd be more concerned about what is increasing your symptoms. Are you missing some post meal high's? What has changed?
 
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Bluetit1802

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I can't see that it matters at all that you are higher when you wake up than 2 hours later at the surgery. It is unusual for surgeries to still be doing the fasting blood glucose test anyway. Perhaps you should continue testing during the day, before and after meals, on a regular basis to see if you are trending upwards.
 

Alexandra100

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I thought I had things under control (with LC diet + metformin) and had mostly stopped testing sugars, but I've been noticing an uptick in symptoms (excessive thirst, urination, hunger) so have started up again to try to see what's happening. One thing I notice is that my sugars right when I get up (say, 6:30) are much higher than they are a couple hours later (say, 8:30), which is the time I get bloods drawn for quarterly testing. My fasting quarterly tests have been okay (remaining in prediabetes, usually low prediabetic, range) but my waking levels are higher these days. I understand that this is likely due to dawn phenomenon, which then dissipates as I get up, move around, etc. over the next few hours. But, does it matter that my waking #s are high (crossing into "diabetic" range)? Can't find much info on this, so if you know of any I'd appreciate it. Thanks!
Have you considered what and when you eat the night before? It is possible that eating less / earlier might help your morning fasting bg, or alternatively some people find consuming a little something just before bed helps. I believe Metformin is supposed to help fasting bg, in which case increasing your dose might help. You don't say how you are eating, but given your symptoms, I would be inclined to cut the carb content of my diet and see if that helps.
 

Glink

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Prediabetes
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Tablets (oral)
I eat pretty much the same every day now, thanks to diabetes & allergies. I usually bike commute and find I have to eat something filling before biking to/from work:
Breakfast: 2 chicken sausages (1 g carb) & coffee w almond milk (6g)
10:30 snack: handful of nuts (usually almonds, sometimes mixed, about 6-10g net?)
Lunch: salad consisting of a head of lettuce, smoked fish (no sugar) and dressing (1g). Sometimes egg or a carrot (4g) or cucumber as well if I have them around.
Afternoon snack: coffee & nuts or small apple w. nut butter (6-20 g depending on how much and whether apple or not)
Dinner: some sort of meat or fish cooked with a lot of veg, usually some combo of broccoli, zucchini, celery, kale (~13 g net carb, avg)

Probably 50-75 g carb net each day these days. I used to be more hardcore LC but I got so tired of going to bed hungry every night, and I was losing almost too much weight (I am fairly thin to begin with). However, I haven't made any big changes to my diet in, oh, a year? More? Nothing that should be making things change now, anyway.

I've been ravenously hungry the past week or so and eating more nuts, which I know is more carbs, but...I'm hungry and they are filling and low carb. I can't find any reason for the uptick in symptoms, but I'm not scheduled to see my GP until June and if my FBG is fine at mid morning I don't think he'll see the problem unless my HbA1c is bad. So far my HbA1c has been shockingly good despite waking highs and inability to tolerate eating many carbs or virtually any grains without spiking and passing out.
 
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Geordie_P

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I eat pretty much the same every day now, thanks to diabetes & allergies. I usually bike commute and find I have to eat something filling before biking to/from work:
Breakfast: 2 chicken sausages (1 g carb) & coffee w almond milk (6g)
10:30 snack: handful of nuts (usually almonds, sometimes mixed, about 6-10g net?)
Lunch: salad consisting of a head of lettuce, smoked fish (no sugar) and dressing (1g). Sometimes egg or a carrot (4g) or cucumber as well if I have them around.
Afternoon snack: coffee & nuts or small apple w. nut butter (6-20 g depending on how much and whether apple or not)
Dinner: some sort of meat or fish cooked with a lot of veg, usually some combo of broccoli, zucchini, celery, kale (~13 g net carb, avg)

Probably 50-75 g carb net each day these days. I used to be more hardcore LC but I got so tired of going to bed hungry every night, and I was losing almost too much weight (I am fairly thin to begin with). However, I haven't made any big changes to my diet in, oh, a year? More? Nothing that should be making things change now, anyway.

I've been ravenously hungry the past week or so and eating more nuts, which I know is more carbs, but...I'm hungry and they are filling and low carb. I can't find any reason for the uptick in symptoms, but I'm not scheduled to see my GP until June and if my FBG is fine at mid morning I don't think he'll see the problem unless my HbA1c is bad. So far my HbA1c has been shockingly good despite waking highs and inability to tolerate eating many carbs or virtually any grains without spiking and passing out.
Your diet looks pretty good for someone as active as yourself: if you need to make cuts though, I guess you could replace the apple, the carrot and maybe the cucumber with, say, another serving of fish. I just mean because those things won't fill you up *that* much in proportion to the amount of sugar they have. I'd even be inclined to have more nuts instead- more filling for the equivalent amount of carb.
 

Alexandra100

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I've been ravenously hungry the past week or so and eating more nuts, which I know is more carbs, but...I'm hungry and they are filling and low carb
I suspect that ravenous hunger can be caused by either high or low bg. If it's not too inconvenient, it might be worth testing when you feel really hungry to see what is happening. You say you are also very thirsty. Sometimes thirst can be mistaken for hunger. If you don't want to lose weight, cheddar cheese and hard-boiled eggs with Hellman's Real mayonnaise are useful low carb snacks. I suggest replacing the almond milk with double cream, thus saving 5.5g carbs and gaining some calories. Consuming the almonds as whole nuts would be more satisfying. I am currently trying to gain weight on a very low carb diet, and I am eating lots of mayonnaise with cold salmon, chicken, salad. Or chicken with butter. Grated cheese in chicken soup. Grated cheese on just about everything. I did try cheddar cheese spread with slabs of butter, but although this was a good combination, I ended up feeling sick!
 
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KK123

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Glink, What exactly are your morning readings? Sometimes I wonder whether individuals are striving for something virtually impossible. Even a 'normal' person's readings fluctuate and can be higher in the mornings. Before most of us were diagnosed or before we first started testing our levels because of some suspicion, how would we KNOW what our body's 'normal' levels were, ie when we definitely didn't have diabetes? I would not have a clue what was normality for my body before it all started to go haywire. If for example, (long before my pancreas started playing up) and I am 57 now and just diagnosed, I may well have been rising on a 6 or whatever. If that is the case, how on earth could I hope for it to be lower once diagnosed, even a NO carb diet would be unlikely to lower it to less than what is the norm for my body? (I appreciate insulin can do this so I guess I am on about those not on medication). Apologies if yours are sky high though Glink.
 

Glink

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Prediabetes
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I'm allergic to milk and soy, so cheese, cream, butter, and mayo (most have soy in them) are not part of my diet.
I'm not trying to lose or gain weight, just stay healthy as possible.

My morning readings, which when I started with LC diet would be in the 4' or low 5's, are around 7 these days. 2h later it's more like high 5's. I don't know if it matters that my actual waking numbers are increasingly diabetic, if my later-morning fasting #s are still prediabetic.

By the numbers all of those readings seem not that bad, but I seem to develop symptoms at lower levels than many--it's the only reason I was diagnosed, actually. Nothing else would explain the symptoms I was having a few years ago (thirst, frequency, fatigue, blurry vision, irritability) so they tested my sugars, which were surprisingly high for a thin, fit, 30-something. When I went LC and got the sugars down to normal, the symptoms went away. I suspect that until things went haywire my "normal" was quite low--in fact years back I had been told I experienced hypoglycemia and should always carry nuts with me when I drove. (I have literally never had a reading below 4.1 since I have been testing, so hypo of any sort seems not to be the issue anymore!)

I've been testing again, not all the time, but in the morning and when I feel weird, and these fasting readings range from high 5's to low 9's. Again, not terrible, but it seems likely that these are the culprits.

Sounds like there aren't really any answers to my question (and heaven knows my GP will have no clue) so I guess I'll just ride this out and see what happens. Hopefully things will magically improve. (It wouldn't be the first time things seemed to go off the rails but somehow righted again.)
 

Alexandra100

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I'm allergic to milk and soy, so cheese, cream, butter, and mayo (most have soy in them) are not part of my diet.
Hellman's "Real Mayonnaise", IMO delicious, contains no soy and only 1.3g carb per 100g. I am extremely pleased to see that they use free range eggs.
 

Alexandra100

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My morning readings, which when I started with LC diet would be in the 4' or low 5's, are around 7 these days. 2h later it's more like high 5's. I don't know if it matters that my actual waking numbers are increasingly diabetic, if my later-morning fasting #s are still prediabetic.
My non-expert thought would be that what counts is how much time one is spending with one's bg at a high enough level to be harmful. And like you, I strongly suspect that in my case the harms start at a much lower level of bg than is usually thought to be the case, especially by health professionals. My worst A1c last summer was 41, which in the UK (though not the US) is just below pre-diabetes. My latest one (after reducing carbs) was 37, but I go along with the many research studies that indicate that with an average bg over 5.4 or an A1c over 34 (or even 31) the heart is already at risk, albeit not hugely. I would dearly like to get my readings down to these numbers, but in spite of my very low carb efforts this is not happening. I suspect that I am pre-LADA, and therefore all my efforts will not bring me the results that T2s often seem to get with low carb.

How much Metformin are you taking?
 

Glink

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Prediabetes
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Tablets (oral)
I'm on 500 mg 2x / day of metformin. If these symptoms and higher readings keep up I'll ask about increasing it at my next appt in June. I hate to deal with the GI effects of changing dose, but once through the transition, it does seem to help with the rises (or at least has in the past, both when I started @ 250 bid and then I upped to 500). My GP has previously offered to put me on a second med, but the other ones he's offered all carry the risk of hypos, and I'd rather not deal with that if at all possible.

Because I'm at risk of actually being LADA/1.5, I get nervous when things suddenly seem worse. I have to remind myself that sometimes it's a new turn in the road, but other times it's just very early signs that I'm actually just getting a temporary virus or something (sugars always seem to go out of whack before I can even feel that I'm sick in other ways--in fact this whole diabetic path seemed to be triggered by a bout of mononucleosis a few years back!).
 

Tophat1900

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I think what matters is what it is when you normally test on any given day. Mine are always different if you compared the lab test result, several hrs later then when I'd normally test.... if I test in the morning.
 

Alison Campbell

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Because I'm at risk of actually being LADA/1.5

I think I remember you posting that you can't get GAD tested where you are. Not sure if you are aware of this but if you have any close relatives that are type 1 and you are under 45 you get can get free screening from this international research organisation.
https://www.trialnet.org/
 

Glink

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Thanks, Alison. Have seen that but no known relatives with T1D. Oh well. I will be moving internationally over the summer, so once I'm settled with new care providers in my new situation, I'll see if they'll do GAD testing. I know it's a "yes means probably; no means maybe" kind of thing, but I'd still like to know.
 
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